18 answers

Can Someone Help Me Understand My Health Care Options?

So I have never had health insurance in my adult life, except when I was pregnant and on medicaid. So I really don't know a good price for it. My husband's former employer offered it for $240 a week with and the deductible was monthly not annual. He has recenlty switched jobs and they gave him some information on the health care plans. He will be eligiable in about two more months but has to sign up for a plan (if he chooses to) in one more month.

My first question is, since he has to sign up for one of the plans 60 days from his hire date would we start being charged the premiums then, even though we would not be covered intill he has been there 90 days?

My second question is, the plan costs about $63 a month for the entire family with a $500 indivual deductible (annual) and $1,500 family deductible, is this a good price for this deductible? Of course this is assuming that our doctors are in the network. We have to drive 30 minutes to get to any hospital of doctor's office so I really don't want to drive farther to find an in the network doctor is ours aren't.

We really need health insurance because I have been getting alot of medical bills lately, and they aren't going to stop coming for a while. However most of the more expensive procedurs are done, and my husband will have to take on a second job to make up for the money that will come out of his check for the premiums. Luckily his old employer agreed to let him come back to work weekends.

Most of things that we know we would be using are covered without meeting the deductible. For example well child checkups for my kids (the kids are currently covered with medicaid, so they are covered now, but we would obviouly switch the coverage). They cover annual pap smears, but I need them every three months for the next two years, so I am not sure how that would work. Does anyone know? Would the doctors fee be counted under specialst and office visits?

Any insight on this would be helpful. Like I said I have never had coverage so this is all new to me.

What can I do next?

So What Happened?™

Im sorry I mistyped! I ment to say $63 a week not a month lol

Featured Answers

My family plan has no deductible, but I pay $425 a month (my employer pays the other 75% - the actual policy is $1700 a month). Sounds like a steal - definitely enroll.

1 mom found this helpful

Thats sounds really good. Mine is $144 per pay period and $4000 deductible and that just covers me and my son. We had another option that was $178 per pay period and a $3000 deductible.
You would pay a co-pay each time you'd go for a PAPsmear since only 1 is covered per year. I don't think that they are a specialist.

More Answers

$63 is a steal.

Don't worry about fighting the system yet - they all have their pitfalls. As a consumer, you can't shop by "what ifs". They ain't gonna tell you upfront, and you can't predict the future.

Cross those bridges when you get there. Right now, make sure all the forms are filled out correctly and get going on that $63! :)

3 moms found this helpful

$63 /mo is pretty cheap. Makes me wonder what it covers. Regardless it should be a better deal than not getting one.

It seems to pay for preventative care, all well visits for the kids, annual paps (annual indicates once a year so it would not cover your 3 other pap smears).

Find out too if it will cover anything related to pre-existing conditions. Most insurance will not pay for them.

Do you have to pay copays over the deductible? Sometimes this can be a percentage and sometimes a $ amount that unfortunately does not apply to your deductible.

You said you have plan choices. Are they all the same price? I wonder if this cheap price also with a Health Savings Account.

PM me if you want. I used to work for a major insurance co in my life before children. I won't be able to help you with what to choose but can maybe help you understand your choices better.

2 moms found this helpful

Your insurance won't cover the bills you already have. Your cost and deductibles are a dream. (Are you sure it's $63 for your family, and not per person?) My husband's costs several hundred a month just for him, with a $10,000 a year deductible...and that's not uncommon.

All the other questions you have, need to be directed at HR. You should have a benefits coordinator or HR representative, that knows the ins and outs of these plans.

2 moms found this helpful

My husband and I are insurance agents. We pay $480 per month for a TEN THOUSAND DOLLAR deductible. So ya, $63 is something to be happy about. Make sure you get a "summary" of coverages so you understand exactly what you are getting. If you don't understand, ask your HR benefit rep OR call the insurance company offering the plan and ask them. Good luck.

2 moms found this helpful

These are questions your DH needs to ask his benefits coordinator where he works.

I can answer one of them, though - yes, that is a HECK of a deal. I haven't seen an employee sponsored health plan for that cheap... well, ever!

2 moms found this helpful

that deductible is average, but if the monthly fee is really only $63, then that's a steal. You didn't say how many are in your family..? At my last job, I had a full comprehensive plan (medical, dental, vision etc..) for my daughter and I, at $96 per month, with a zero deductible, co-pays were $20, scripts were $10. That was the best price I ever paid for full insurance, I wish I still had it!!! One thing you'll want to do, is look at the pre-existing clause, if there is one. I had an employer based insurance several years back, that wouldn't cover anything to do with my thyroid disease (which I was diagnosed with 15 years go and take daily medicine) for one year, because they considered it pre-existing. That was such BS, and the WORST insurance I had...

1 mom found this helpful

I'd jump on that all day long...twice on Sundays. :)

1 mom found this helpful

That sounds like a reasonable plan. Driving 30 minutes to the network doc beats the alternative. Most prompt care places take all insurance, but docs not in your network will be very pricey.
ETA
63 a week is a lot less that what we pay for our HMO, we pay a little over 100 a week for two of us

1 mom found this helpful

Your new insurance is EXTREMELY affordable! When I was employed, my insurance was a little over $400/month for the entire family w/a $500 individual deductible (can't remember the family deductible). It also covered maternity.
My husband is self-employed and I am a SAHM, so now we carry an individual policy. It sucks. We pay around $450/month with $1500/$5000 deductible. Our policy does cover well child checks and immunizations, but not maternity. We get 3 sick visits per person at a $35 copay (that does not go toward the deductible) and after that, the copay is a negotiated rate between insurance and the doctor. Our policy now is much better than our last one. The last one started out fairly similar to our current one and would raise us about every six months or so. We ended up paying $540/month with a $10,000 deductible!! It was basically catastrophic only.
So yes, your husband's policy sounds fabulous!!
To answer your question, your paps would go towards your deductible (minus one annual). So, you pay for them until you have paid $500. You need to look at whether or not your policy is 100% or 80/20, etc. Sometimes, even after meeting your deductible, you are still responsible for a percent of costs incurred beyond it. So lets say you meet your $500 deductible, but your plan is 80/20 thereafter- you would still be responsible for 20% of the cost of your paps even after the $500 is met.
Usually, you will have a co-pay amount for your regular doctor and a different co-pay amount for any specialists you may see (usually the specialist co-pay is more).
As for out of network providers, I really can't help on that because I've only used in network providers.

1 mom found this helpful

My family plan has no deductible, but I pay $425 a month (my employer pays the other 75% - the actual policy is $1700 a month). Sounds like a steal - definitely enroll.

1 mom found this helpful

I was going to say $63 a month is AWESOME. But for family insurance that is still a good price. That comes to $252 a month. My insurance for family is close to $800 a month with a $3000 deductible if that tells you anything. So what he is offered is GREAT. Snatch it up in a heartbeat.

In regards to pap smears and all of that it would be counted as a doctor visit. It would only be a specialist if you were seeing an actual specialist so you'd have to pay the co-pay of that visit and that's it.

In regards to old hospital bills, depending on what your income was during that time you may be able to get them dropped or reduced if you wanted to talk to the hospital financial services. There are a lot of loop holes there that the hospital won't inform you of.
When he becomes eligible for insurance he should have a meeting set up with HR that will answer any of his questions. If he doesn't make sure he requests that so he will be able to get the answers you need.

Definitely get it. Keep in mind that if the insurance covers just an annual pap, but your gyn says you need them every 3 months, there should be some form or coding he/she can use to say it is necessary and that should be good enough for the insurance to cover it.

We have an HMO. It is totally worth it to drive 30 miles to see an in network doctor. My son needed to see some specialists that were not in our network. The staff at our doctor's office knows what they're doing, because they knew what to say to our insurance company to make sure the visits were covered. I called just to be safe, and the insurance company told be that because his ped said it was necessary and because there are no in network specialists in those areas, that it would be covered.

My husband works for the state. We pay about $175 a month for our insurance? I work for the state too, now, so I have to cover myself (no double dipping). I think I pay around $50 a month. I know that we have awesome insurance coverage.

It sounds like you would be getting an amazing deal as well. Definitley look into the details to make sure it really is just $63 a month, but seriously just go for it! You won't be sorry.

I think that's a decent cost for family per month. And the deductible is awesome. You may also be able to set up a pre tax savings for health costs. My family one is slightly less per month but deductible like 4000

There are hundreds, even thousands, of different types of health insurance coverage. For family coverage, even for the most basic plans, you can expect to pay up to $1,000 per month. So if your paying $63 a week, that means his employer is picking up a large portion of the cost.

In general his employer should not be deducting insurance premiums until the coverage begins. However, they may do this since premiums need to be paid in advance. You should check with his employer.

You need to get information on all the types of plans you have available and compare them based on your family's needs. Check to see what doctors/hospitals are in your network. What's covered and not covered. If you have specific questions the pertain to your situation (like the pap smears) then ask questions. If possible, put them in writing.

i would have to double check that premium. that doesnt't sound likely at all. especially with such a low deductible...but i could be wrong. i just recently bought ours myself because my work plan was almost $300 per month. and mine is still $250 per month through bcbs. but we got a low deductible, copays, prescription plan, and free well checkups for all of us. the plan through my work included none of that - a flat $5,000 deductible for EVERYTHING. ridiculous.

i believe your questions should be answered by the insurance rep or HR at husband's work. but it does sound too good to be true, imo. (i'd also be really surprised if more than one pap smear is covered annually)

in general i have found VERY little to be happy about in this whole insurance journey. i really hope that yours is that good though! good luck! write down your questions and have hubby take them to work and have them answer for him.

63 a week is a good deal for what you listed. Have your husband look to see why they are deducting 30 days early. Does that mean that you would be covered for 30 days if your husband leaves this job? You can call and make an appointment with HR / Benefits at your husbands company and then the two of you can sit down and make sure that all your questions get answered. Make sure you write them down.

As far as the extra 3 paps - they will probably be covered if there is a medical issue, but they won't be free.

$63.00 a month is an incredible price. I would sign up in a heartbeat!!! Usually you have to be employed for three months. The 60 day decision
is to get the paperwork going and I think the first premium would be due the
third month this way you are covered immediately. Does that make sense.

If the pap is medically necessary every three months, I would think it would
be covered however, do not take that as sure thing.

Thats sounds really good. Mine is $144 per pay period and $4000 deductible and that just covers me and my son. We had another option that was $178 per pay period and a $3000 deductible.
You would pay a co-pay each time you'd go for a PAPsmear since only 1 is covered per year. I don't think that they are a specialist.

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